N.Y. Public Health Law Section 4406-G
Telehealth delivery of services


1.

A health maintenance organization shall not exclude from coverage a service that is otherwise covered under an enrollee contract of a health maintenance organization because the service is delivered via telehealth, as that term is defined in subdivision two of this section; provided, however, that a health maintenance organization may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the enrollee contract. A health maintenance organization may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the enrollee as those established for the same service when not delivered via telehealth. A health maintenance organization may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

2.

For purposes of this section, “telehealth” means the use of electronic information and communication technologies by a health care provider to deliver health care services to an enrollee while such enrollee is located at a site that is different from the site where the health care provider is located. * 3. A health maintenance organization that provides comprehensive coverage for hospital, medical or surgical care shall reimburse covered services delivered via telehealth on the same basis, at the same rate, and to the extent that such services are reimbursed when delivered in person; provided that reimbursement of covered services delivered by means of telehealth shall not require reimbursement of costs not actually incurred in the provision of the telehealth services, including charges related to the use of a clinic or other facility when neither the originating site nor the distant site occur within the clinic or other facility. The commissioner, in consultation with the superintendent, may promulgate regulations to implement the provisions of this section. * NB Repealed April 1, 2026 * 4. A health maintenance organization that provides comprehensive coverage for hospital, medical, or surgical care with a network of health care providers shall ensure that such network is adequate to meet the telehealth needs of insured individuals for services covered under the policy when medically appropriate. * NB Repealed April 1, 2026

Source: Section 4406-G — Telehealth delivery of services, https://www.­nysenate.­gov/legislation/laws/PBH/4406-G (updated Apr. 26, 2024; accessed Dec. 21, 2024).

4400
Statement of policy and purposes
4401
Definitions
4402
Health maintenance organizations
4403
Health maintenance organizations
4403‑A
Special purpose certificate of authority
4403‑B
Development of comprehensive health services plans
4403‑C
Comprehensive HIV special needs plan certification
4403‑D
Special needs managed care plans
4403‑E
Primary care partial capitation providers
4403‑F
Managed long term care plans
4403‑G
Developmental disability individual support and care coordination organizations
4404
Health maintenance organizations
4405
Health maintenance organizations
4405‑A
Immunizations against poliomyelitis, mumps, measles, diphtheria and rubella
4405‑B
Duty to report
4406
Health maintenance organizations
4406‑A
Arbitration provisions of health maintenance organization contracts
4406‑B
Primary and preventive obstetric and gynecologic care
4406‑C
Prohibitions
4406‑D
Health care professional applications and terminations
4406‑E
Access to end of life care
4406‑F
Maternal depression screenings
4406‑G
Telehealth delivery of services
4406‑H
Health care facility applications
4406‑I
Utilization review determinations for medically fragile children
4407
Health maintenance organizations
4408
Disclosure of information
4408‑A
Integrated delivery systems
4408‑A*2
Grievance procedure
4409
Health maintenance organizations
4410
Health maintenance organizations
4411
Construction
4412
Separability
4413
Savings clause
4414
Health care compliance programs
4416
Excess reserves of certain health maintenance organizations

Accessed:
Dec. 21, 2024

Last modified:
Apr. 26, 2024

§ 4406-G’s source at nysenate​.gov

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